Emotional self-knowledge profiles and relationships with mental health indicators support value in 'knowing thyself'.

"Know thyself" may be indicated by a balanced high pairing of two emotional self-knowledge indicators: attention to emotions and emotional clarity. Closely associated but often evaluated separately, emotional clarity is consistently, inversely associated with psychopathology, while evidence regarding attention to emotions is less consistent. Variables of high/low emotional clarity and attention to emotions yielded four emotional self-knowledge profiles which were analyzed for associations with mental health indicators (depression and anxiety symptoms, self-esteem, self-schema, resiliency, transcendence) in n = 264 adolescents. Here we report regression models which show that compared with neither, both high (attention + clarity) show higher positive self-schema (B = 2.83, p = 0.004), more resiliency (B = 2.76, p = 0.015) and higher transcendence (B = 82.4, p < 0.001), while high attention only is associated with lower self-esteem (B = - 3.38, p < 0.001) and more symptoms (B = 5.82, p < 0.001 for depression; B = 9.37, p < 0.001 for anxiety). High attention only is associated with most severe impairment all indicators excepting transcendence. Profiles including high clarity suggest protective effects, and 'implicit' versus 'explicit' emotional awareness are discussed. Balanced vs. imbalanced emotional self-awareness profiles dissimilarly affect mental health, which have implications for treatment and policy.

Spanish Adaptation of the Mentalization Questionnaire (MZQ) in Community Adolescents and Adults.

BACKGROUND: Despite the role of mentalization in mental health outcomes and prevention, psychometrically-evaluated screening measures for mentalization remain sparse. One widely-used mentalization questionnaire is the Mentalization Questionnaire (MZQ; Hausberg et al., 2012), which we aimed to adapt and validate for use in Spanish. METHOD: We adapted the MZQ to European Spanish and evaluated its psychometric properties in both adolescent (n = 389, ages 12-19, M = 14.5) and adult community samples (n = 382, M = 48). RESULTS: Confirmatory factor analysis resulted in a unidimensional structure including all items. This model had better goodness of fit than the original and other adaptations. Invariance analysis showed the same structure in adolescents compared by sex and age, and additionally in the adult versus adolescent samples. Evidence for convergent and discriminant validity was found. Internal consistency values in both adolescents and parents were fair and in the adolescent sample the MZQ scores remained moderately stable after re-test. CONCLUSIONS: The Spanish adaptation of the MZQ presents similar evidence of reliability and validity in the adolescent and adult samples. The results support this being a suitable version for evaluating mentalization in the general population.

Spanish Adaptation of the Mentalization Questionnaire (MZQ) in Community Adolescents and Adults / Adaptación Española del Cuestionario de Mentalización (MentalizationQuestionnaire; MZQ) para Adolescentes y Adultos de Población General

Background: Despite the role of mentalization in mental health outcomes and prevention, psychometrically-evaluated screening measures for mentalization remain sparse. One widely-used mentalization questionnaire is the Mentalization Questionnaire (MZQ; Hausberg et al., 2012), which we aimed to adapt and validate for use in Spanish. Method: We adapted the MZQ to European Spanish and evaluated its psychometric properties in both adolescent (n = 389, ages 12-19, M = 14.5) and adult community samples (n = 382, M = 48). Results: Confirmatory factor analysis resulted in a unidimensional structure including all items. This model had better goodness of fit than the original and other adaptations. Invariance analysis showed the same structure in adolescents compared by sex and age, and additionally in the adult versus adolescent samples. Evidence for convergent and discriminant validity was found. Internal consistency values in both adolescents and parents were fair and in the adolescent sample the MZQ scores remained moderately stable after re-test. Conclusions: The Spanish adaptation of the MZQ presents similar evidence of reliability and validity in the adolescent and adult samples. The results support this being a suitable version for evaluating mentalization in the general population.(AU)

Antecedentes: A pesar del creciente reconocimiento de la mentalización como factor en el desarrollo de la salud mental y la prevención, las medidas de cribado validadas psicométricamente siguen siendo escasas. El Cuestionario de Mentalización (MZQ; Hausberg et al., 2012) es uno de los más utilizados. El objetivo es adaptar y validar su uso al español. Método: Adaptamos el MZQ al español europeo en muestras comunitarias de adolescentes (n = 389, edades 12-19, M = 14,5) y de adultos (n = 382, M = 48). Resultados: Se realizó un análisis factorial confirmatorio que expuso una estructura unifactorial para ambas muestras. Este modelo presentó mejores índices de ajuste que los modelos presentados en la versión original y en las adaptaciones. El estudio de invariancia mostró la misma estructura en la muestra de adolescentes cuando se compararon por sexo y edad, y también en la muestra de adultos comparada con la muestra de adolescentes. Se encontraron evidencias de validez convergente y discriminante. Conclusiones: La adaptación del MZQ al español presenta evidencias de validez y fiabilidad similares en la muestra de adolescentes y en la de adultos. Los resultados apoyan que se trata de una versión apta para evaluar la mentalización en población general.(AU)

I don't understand how I feel: mediating role of impaired self-mentalizing in the relationship between childhood adversity and psychosis spectrum experiences.

Introduction: Childhood adversity is associated with the severity of multiple dimensions of psychosis, but the mechanisms underpinning the close link between the two constructs is unclear. Mentalization may underlie this relationship, as impaired mentalizing is found in various stages of the psychosis continuum. Nonetheless, the differential roles of self- and other-mentalizing in psychosis are not well understood. Methods: Parallel multiple mediation was conducted for the relationship between a diverse range of childhood adversity types, including intentional and nonintentional harm, and schizotypy (positive, negative, disorganized), psychotic-like experiences (PLE) and paranoia via self-mentalizing (attention to emotions and emotional clarity) and other-mentalizing in n = 1,156 nonclinically ascertained young adults. Results: Significant parallel multiple mediation models were found for all psychotic outcomes except negative schizotypy. The associations between intentionally harmful childhood adversity and psychotic outcomes were significantly mediated by increased attention to emotions for most models and decreased emotional clarity for some models. No significant mediation was found for parental loss. Paternal abuse was only mediated by attention to emotions whereas the effects of maternal abuse were mediated by attention to emotions and emotional clarity. Other-mentalizing only showed mediating effects on one of thirty models tested. Conclusion: Results highlight the mediating role of impaired self-mentalizing in the association between childhood adversity and psychosis. This is consistent with disturbances of self-concept and self-boundary characterizing, in particular, the positive dimension of psychosis. Maternal versus paternal figures may contribute differentially to the development of mentalizing. These results could inform future preventative interventions, focusing on the development and maintenance of self-mentalizing.

The moderating role of hair cortisol in the association of early and recent stress with stress-related phenotypes.

Background: Increased hair cortisol concentrations (HCC) have been found in clinical samples of schizophrenia, first episode psychosis and clinical risk for psychosis, but evidence of such is scarce in schizotypy. High HCC are supposed to reflect elevated chronic stress. However, HCC were not directly associated with adversity measures and stress-related phenotypes in previous research. This study tested whether HCC moderated the association between a comprehensive range of psychosocial stressors with several stress-related phenotypes in a sample of nonclinical young adults. It was expected that stressors, either distal (i.e., early-life) or recent, would be associated with subclinical features, particularly for those with elevated HCC, reflecting the effects of a potential biological sensitization to stress. Methods: The sample comprised 132 nonclinical young adults belonging to the Barcelona Longitudinal Investigation of Schizotypy Study (BLISS). Participants completed a questionnaire of childhood adversity and two complementary measures of recent life events, tapping threatening vs. more general life events. Both the frequency and subjective impact (positive vs. negative) of general life events were also assessed. Psychotic (i.e., schizotypy, suspiciousness) and non-psychotic (i.e., depression, anxiety) subclinical features as well as appraisals of perceived stress were examined. Hierarchical linear regressions and simple slope analyses were computed. Results: HCC moderated the effects of both early and recent stress on suspiciousness as well as the effects of recent life events on perceived stress, such that those with higher HCC presented increased suspiciousness and perceived stress at higher levels of stress exposure. Positive, but not negative, recent life events were associated with decreased perceived stress and depression, and these associations were moderated by low HCC, indicating a buffering effect for those with a non-impaired HPA axis. Conclusion: In line with the neural diathesis-stress model, results highlight the role of the interplay between the HPA axis and exposure to stressful experiences in exacerbating psychosis features and extend evidence to the nonclinical expression of the psychosis continuum. In addition, findings support the protective effect of positive experiences in decreasing stress appraisals and affective disturbances, which is consistent with emerging research about the relevance of positive factors in reducing the likelihood of psychopathological outcomes.

Schizophrenia polygenic risk score in psychosis proneness.

Schizophrenia (SZ) is a complex disorder with a highly polygenic inheritance. It can be conceived as the extreme expression of a continuum of traits that are present in the general population often broadly referred to as schizotypy. However, it is still poorly understood how these traits overlap genetically with the disorder. We investigated whether polygenic risk for SZ is associated with these disorder-related phenotypes (schizotypy, psychotic-like experiences, and subclinical psychopathology) in a sample of 253 non-clinically identified participants. Polygenic risk scores (PRSs) were constructed based on the latest SZ genome-wide association study using the PRS-CS method. Their association with self-report and interview measures of SZ-related traits was tested. No association with either schizotypy or psychotic-like experiences was found. However, we identified a significant association with the Motor Change subscale of the Comprehensive Assessment of At-Risk Mental States (CAARMS) interview. Our results indicate that the genetic overlap of SZ with schizotypy and psychotic-like experiences is less robust than previously hypothesized. The relationship between high PRS for SZ and motor abnormalities could reflect neurodevelopmental processes associated with psychosis proneness and SZ.

Empirically-derived dimensions of childhood adversity and cumulative risk: associations with measures of depression, anxiety, and psychosis-spectrum psychopathology.

Background: Investigating different approaches to operationalizing childhood adversity and how they relate to transdiagnostic psychopathology is relevant to advance research on mechanistic processes and to inform intervention efforts. To our knowledge, previous studies have not used questionnaire and interview measures of childhood adversity to examine factor-analytic and cumulative-risk approaches in a complementary manner.Objective: The first aim of this study was to identify the dimensions underlying multiple subscales from three well-established childhood adversity measures (the Childhood Trauma Questionnaire, the Childhood Experience of Care and Abuse Interview, and the Interview for Traumatic Events in Childhood) and to create a cumulative risk index based on the resulting dimensions. The second aim of the study was to examine the childhood adversity dimensions and the cumulative risk index as predictors of measures of depression, anxiety, and psychosis-spectrum psychopathology.Method: Participants were 214 nonclinically ascertained young adults who were administered questionnaire and interview measures of depression, anxiety, psychosis-spectrum phenomena, and childhood adversity.Results: Four childhood adversity dimensions were identified that captured experiences in the domains of Intrafamilial Adversity, Deprivation, Threat, and Sexual Abuse. As hypothesized, the adversity dimensions demonstrated some specificity in their associations with psychopathology symptoms. Deprivation was uniquely associated with the negative symptom dimension of psychosis (negative schizotypy and schizoid symptoms), Intrafamilial Adversity with schizotypal symptoms, and Threat with depression, anxiety, and psychosis-spectrum symptoms. No associations were found with the Sexual Abuse dimension. Finally, the cumulative risk index was associated with all the outcome measures.Conclusions: The findings support the use of both the empirically-derived adversity dimensions and the cumulative risk index and suggest that these approaches may facilitate different research objectives. This study contributes to our understanding of the complexity of childhood adversity and its links to different expressions of psychopathology.

We investigated how different approaches to operationalizing childhood adversity relate to transdiagnostic psychopathology.Four childhood adversity dimensions were found to underlie multiple subscales from three well-established childhood adversity measures.The childhood adversity dimensions demonstrated some specificity in their associations with the psychopathology symptom domains and the cumulative risk index was associated with all the outcomes.

Social connectedness and resilience post COVID-19 pandemic: Buffering against trauma, stress, and psychosis.

The present study investigated psychosocial predictors of psychosis-risk, depression, anxiety, and stress in Croatia two years after the onset of the COVID-19 pandemic. Given the existing transgenerational war trauma and associated psychiatric consequences in Croatian population, a significant pandemic-related deterioration of mental health was expected. Recent studies suggest that after an initial increase in psychiatric disorders during the pandemic in Croatia, depression, stress, and anxiety rapidly declined. These findings highlight the role of social connectedness and resilience in the face of the global pandemic. We examined resilience and psychiatric disorder risk in 377 Croatian adults using an anonymous online mental health survey. Results indicate that there was an exacerbation of all mental ill health variables, including depression, anxiety, stress, and a doubled risk for psychosis outcome post-COVID pandemic. Stress decreased levels of resilience, however, those exposed to previous traumatic experience and greater social connectedness had higher resilience levels. These findings suggest that individual differences in underlying stress sensitization of Croatian population due to past trauma may continue to influence mental health consequences two years after COVID-19 pandemic. It is essential to promote the importance of social connectedness and resilience in preventing the development of variety of mental health disorders.

Influence of cannabis use on incidence of psychosis in people at clinical high risk.

AIMS: Evidence for case-control studies suggests that cannabis use is a risk factor for the development of psychosis. However, there have been limited prospective studies and the direction of this association remains controversial. The primary aim of the present study was to examine the association between cannabis use and the incidence of psychotic disorders in people at clinical high risk of psychosis. Secondary aims were to assess associations between cannabis use and the persistence of psychotic symptoms, and with functional outcome. METHODS: Current and previous cannabis use were assessed in individuals at clinical high risk of psychosis (n = 334) and healthy controls (n = 67), using a modified version of the Cannabis Experience Questionnaire. Participants were assessed at baseline and followed up for 2 years. Transition to psychosis and persistence of psychotic symptoms were assessed using the Comprehensive Assessment of At-Risk Mental States criteria. Level of functioning at follow up was assessed using the Global Assessment of Functioning disability scale. RESULTS: During follow up, 16.2% of the clinical high-risk sample developed psychosis. Of those who did not become psychotic, 51.4% had persistent symptoms and 48.6% were in remission. There was no significant association between any measure of cannabis use at baseline and either transition to psychosis, the persistence of symptoms, or functional outcome. CONCLUSIONS: These findings contrast with epidemiological data that suggest that cannabis use increases the risk of psychotic disorder.

Psychosocial factors associated with the risk of developing psychosis in a Mexican general population sample.

Epidemiological evidence has linked an array of sociodemographic and psychosocial factors with an increased risk of developing psychosis. However, research in samples from low- and middle-income countries is still scarce. This study used a Mexican sample to explore (i) sociodemographic and psychosocial differences between individuals with and without a positive screen for Clinical High-Risk for psychosis (CHR), and (ii) sociodemographic and psychosocial factors associated with screening positive for CHR. The sample consisted of 822 individuals from the general population who completed an online survey. Of the participants, 17.3% (n = 142) met the CHR screening criteria. Comparisons between those who screened positive (CHR-positive group) and those who did not (Non-CHR group) showed that participants in the CHR-positive group were younger, had a lower educational level, and reported more mental health problems than the Non-CHR group. Furthermore, relative to the Non-CHR group, the CHR-positive group had a greater prevalence of medium/high risk associated with cannabis use, a higher prevalence of adverse experiences (bullying, intimate partner violence, and experiencing a violent or unexpected death of a relative or friend), as well as higher levels of childhood maltreatment, poorer family functioning, and more distress associated with the COVID-19 pandemic. Groups did not differ in sex, marital/relationship status, occupation, and socio-economic status. Finally, when examined in multivariate analyses, the variables associated with screening positive for CHR were: having an unhealthy family functioning (OR = 2.75, 95%CI 1.69-4.46), a higher risk associated with cannabis use (OR = 2.75, 95%CI 1.63-4.64), a lower level of education (OR = 1.55, 95%CI 1.003-2.54), having experienced a major natural disaster (OR = 1.94, 95%CI 1.18-3.16), having experienced a violent or unexpected death of a relative or friend (OR = 1.85, 95%CI 1.22-2.81), higher levels of childhood emotional abuse (OR = 1.88, 95%CI 1.09-3.25), physical neglect (OR = 1.68, 95%CI 1.08-2.61), and physical abuse (OR = 1.66, 95%CI 1.05-2.61), and higher COVID-related distress (OR = 1.10, 95%CI 1.01-1.20). An older age was a protective factor for screening positive for CHR (OR = 0.96, 95%CI 0.92-0.99). Overall, the findings highlight the importance of examining potential psychosocial contributors to psychosis vulnerability across different sociocultural contexts to delineate risk and protective processes relevant to specific populations and better target preventive intervention efforts.

A psychosocial pathway to paranoia: The interplay between social connectedness and self-esteem.

The quantity and quality of social contacts have been related to self-esteem, and both social relationships and self-esteem have been implicated in the pathways to paranoia. However, how social relationships interplay with self-esteem to trigger paranoia is not well understood. This study aims to investigate whether different measures of social connectedness (social support, loneliness, and desired friendship), as well as the frequency of social contact, impact paranoia and other positive and negative psychotic-like experiences (PLE) through the indirect effect of self-esteem. Data from a sample of 169 nonclinically ascertained participants oversampled for schizotypy scores were analyzed using two different approaches: retrospective trait-like and ecological momentary measures of social connectedness. Results showed that self-esteem mediates the pathways from poor social support and social longing, but not from loneliness, to paranoia and other cognitive PLE. In contrast, pathways from social connectedness to perceptual PLE and negative PLE were not mediated by self-esteem. Results were consistent across trait-like and momentary measures. Finally, self-esteem was not implicated in the pathways from the frequency of social contact and paranoia or other forms of PLE. These results provide a comprehensive picture of how social connectedness drives specific symptoms of psychosis through self-esteem. Findings underscore the need to explore separately the quality and quantity of social relationships and suggest that the subjective experience of meaningful social bonds is key social determinants of mental health. Therefore, addressing inadequacies of social connectedness could substantially improve symptomatic and functional outcomes of psychosis.

Serum immune markers and transition to psychosis in individuals at clinical high risk.

Individuals at clinical high risk (CHR) for psychosis have been found to have altered cytokine levels, but whether these changes are related to clinical outcomes remains unclear. We addressed this issue by measuring serum levels of 20 immune markers in 325 participants (n = 269 CHR, n = 56 healthy controls) using multiplex immunoassays, and then followed up the CHR sample to determine their clinical outcomes. Among 269 CHR individuals, 50 (18.6 %) developed psychosis by two years. Univariate and machine learning techniques were used to compare levels of inflammatory markers in CHR subjects and healthy controls, and in CHR subjects who had (CHR-t), or had not (CHR-nt) transitioned to psychosis. An ANCOVA identified significant group differences (CHR-t, CHR-nt and controls) and post-hoc tests indicated that VEGF levels and the IL-10/IL-6 ratio were significantly higher in CHR-t than CHR-nt, after adjusting for multiple comparisons. Using a penalised logistic regression classifier, CHR participants were distinguished from controls with an area-under the curve (AUC) of 0.82, with IL-6 and IL-4 levels the most important discriminating features. Transition to psychosis was predicted with an AUC of 0.57, with higher VEGF level and IL-10/IL-6 ratio the most important discriminating features. These data suggest that alterations in the levels of peripheral immune markers are associated with the subsequent onset of psychosis. The association with increased VEGF levels could reflect altered blood-brain-barrier (BBB) permeability, while the link with an elevated IL-10/IL-6 ratio points to an imbalance between anti- and pro-inflammatory cytokines.

Impact of adverse childhood experiences on educational achievements in young people at clinical high risk of developing psychosis.

BACKGROUND: Adverse childhood experiences (ACE) can affect educational attainments, but little is known about their impact on educational achievements in people at clinical high risk of psychosis (CHR). METHODS: In total, 344 CHR individuals and 67 healthy controls (HC) were recruited as part of the European Community's Seventh Framework Programme-funded multicenter study the European Network of National Schizophrenia Networks Studying Gene-Environment Interactions (EU-GEI). The brief version of the Child Trauma Questionnaire was used to measure ACE, while educational attainments were assessed using a semi-structured interview. RESULTS: At baseline, compared with HC, the CHR group spent less time in education and had higher rates of ACE, lower rates of employment, and lower estimated intelligence quotient (IQ). Across both groups, the total number of ACE was associated with fewer days in education and lower level of education. Emotional abuse was associated with fewer days in education in HC. Emotional neglect was associated with a lower level of education in CHR, while sexual abuse was associated with a lower level of education in HC. In the CHR group, the total number of ACE, physical abuse, and neglect was significantly associated with unemployment, while emotional neglect was associated with employment. CONCLUSIONS: ACE are strongly associated with developmental outcomes such as educational achievement. Early intervention for psychosis programs should aim at integrating specific interventions to support young CHR people in their educational and vocational recovery. More generally, public health and social interventions focused on the prevention of ACE (or reduce their impact if ACE occur) are recommended.

Replication of the associations of positive, negative, and disorganized schizotypy with interview-assessed symptoms and impairment: Convergence with previous studies.

Schizophrenia-spectrum psychopathology appears best understood as being expressed across a continuum of clinical and subclinical symptoms and impairment referred to as schizotypy. This brief report describes a comprehensive replication study examining the associations of positive, negative, and disorganized schizotypy with interview ratings of impairment, psychopathology, and personality pathology in a sample of 161 young adults. Consistent with past studies, positive, negative, and disorganized schizotypy had distinct and hypothesized associations with symptoms and impairment. Positive schizotypy was associated with prodromal symptoms and schizotypal, paranoid, and borderline personality traits. Negative schizotypy was associated with impaired functioning, negative symptoms, and schizoid, schizotypal, and paranoid traits, as well as any broad personality disorder diagnosis; it was also associated with never having dated. Disorganized schizotypy was associated with impaired functioning, disorganized schizotypic experiences, attentional deficits, and schizotypal, paranoid, borderline, and avoidant personality traits, as well as depression. Overall, we successfully replicated findings from five previous schizotypy interview studies, supporting the construct validity of the multidimensional model of schizotypy and the Multidimensional Schizotypy Scale. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Affective dynamics in daily life are differentially expressed in positive, negative, and disorganized schizotypy.

Schizotypy and schizophrenia are associated with disruptions in the experience of affect. Temporal patterns of affect, or affective dynamics, offer unique information about the expression of multidimensional schizophrenia-spectrum psychopathology. The present study employed experience sampling methodology to examine affective intensity, inertia, variability, reactivity, and instability in positive, negative, and disorganized schizotypy in nonclinically ascertained young adults (n = 275). As hypothesized, disorganized schizotypy demonstrated the most robust associations with affective dynamics and was characterized by elevated intensity, reactivity, and variability of negative affect. Disorganized schizotypy was also associated with instability of negative affect, but this relation was better accounted for by mean negative affect, which was elevated in disorganized schizotypy. Negative schizotypy was characterized by diminished intensity and variability of positive affect as expected, but was unassociated with affective inertia. Finally, as hypothesized, positive schizotypy was associated with elevated intensity and variability of negative affect at the bivariate level, but was unassociated with affective dynamics when including disorganized schizotypy in the model. These findings indicate that the schizotypy dimensions are differentiated by both mean levels and dynamics of affect, and that affective dynamics convey unique information about multidimensional schizotypy beyond mean levels of affect. The findings provide further support for the multidimensional model of schizotypy. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Speech Illusions in People at Clinical High Risk for Psychosis Linked to Clinical Outcome.

BACKGROUND AND HYPOTHESIS: Around 20% of people at clinical high risk (CHR) for psychosis later develop a psychotic disorder, but it is difficult to predict who this will be. We assessed the incidence of hearing speech (termed speech illusions [SIs]) in noise in CHR participants and examined whether this was associated with adverse clinical outcomes. STUDY DESIGN: At baseline, 344 CHR participants and 67 healthy controls were presented with a computerized white noise task and asked whether they heard speech, and whether speech was neutral, affective, or whether they were uncertain about its valence. After 2 years, we assessed whether participants transitioned to psychosis, or remitted from the CHR state, and their functioning. STUDY RESULTS: CHR participants had a lower sensitivity to the task. Logistic regression revealed that a bias towards hearing targets in stimuli was associated with remission status (OR = 0.21, P = 042). Conversely, hearing SIs with uncertain valence at baseline was associated with reduced likelihood of remission (OR = 7.72. P = .007). When we assessed only participants who did not take antipsychotic medication at baseline, the association between hearing SIs with uncertain valence at baseline and remission likelihood remained (OR = 7.61, P = .043) and this variable was additionally associated with a greater likelihood of transition to psychosis (OR = 5.34, P = .029). CONCLUSIONS: In CHR individuals, a tendency to hear speech in noise, and uncertainty about the affective valence of this speech, is associated with adverse outcomes. This task could be used in a battery of cognitive markers to stratify CHR participants according to subsequent outcomes.

Association of Multidimensional Schizotypy with PID-5 Domains and Facets.

The underlying vulnerability for schizophrenia-spectrum disorders is expressed across a continuum of clinical and subclinical symptoms referred to as schizotypy. Schizotypy is a multidimensional construct with positive, negative, and disorganized dimensions. The present study examined associations of positive, negative, and disorganized schizotypy with pathological personality traits and facets assessed by the Personality Inventory for DSM-5 (PID-5) in 1,342 young adults. As hypothesized, positive schizotypy was associated with the PID-5 psychoticism domain and facets, negative schizotypy was associated with the detachment domain and facets and the restricted affectivity facet, and disorganized schizotypy's strongest associations were with the distractibility and eccentricity facets and the negative affect domain. The PID-5 facets accounted for upwards of two thirds of the variance in each schizotypy dimension. The authors conclude by providing regression-based algorithms for computing positive, negative, and disorganized schizotypy scores based on the PID-5 facets.

Loneliness and psychosocial predictors of psychosis-proneness during COVID-19: Preliminary findings from Croatia.

The present study investigated psychosocial predictors of psychosis-risk, depression, anxiety, and stress in Croatia during the COVID-19 pandemic. Given Croatia's recent transgenerational war trauma and the relative lack of available prodromal data, this study presents a unique opportunity to examine the impact of loneliness and other psychosocial factors on psychosis-risk and mental health in this population. 404 Croatian participants completed an anonymous online survey of physical and mental health questions. 48 participants met the criteria for elevated psychosis-risk on prodromal questionnaire (PQ-16). Loneliness had a significant impact on psychosis-risk. Exposure to trauma was associated with psychosis-risk and loneliness, while domestic abuse/violence was associated only with the distress surrounding psychotic-like symptoms. COVID concern was also associated with psychosis-risk. Lastly, the associations between psychosis-risk and depression, anxiety, and stress were robust. These findings highlight the important role of loneliness in psychosis-proneness in Croatia. Depression, anxiety, and stress were also closely related to elevated psychosis-risk. Loneliness is a highly salient issue for individuals with psychosis and it is important to target loneliness within a multi-faceted psychosocial intervention for those at risk for schizophrenia.

Differential trajectories of tobacco smoking in people at ultra-high risk for psychosis: Associations with clinical outcomes.

Objective: People at ultra-high risk (UHR) for psychosis have a high prevalence of tobacco smoking, and rates are even higher among the subgroup that later develop a psychotic disorder. However, the longitudinal relationship between the course of tobacco smoking and clinical outcomes in UHR subjects is unknown. Methods: We investigated associations between tobacco smoking and clinical outcomes in a prospective study of UHR individuals (n = 324). Latent class mixed model analyses were used to identify trajectories of smoking severity. Mixed effects models were applied to investigate associations between smoking trajectory class and the course of attenuated psychotic symptoms (APS) and affective symptoms, as assessed using the CAARMS. Results: We identified four different classes of smoking trajectory: (i) Persistently High (n = 110), (ii) Decreasing (n = 29), (iii) Persistently Low (n = 165) and (iv) Increasing (n = 20). At two-year follow-up, there had been a greater increase in APS in the Persistently High class than for both the Persistently Low (ES = 9.77, SE = 4.87, p = 0.046) and Decreasing (ES = 18.18, SE = 7.61, p = 0.018) classes. There were no differences between smoking classes in the incidence of psychosis. There was a greater reduction in the severity of emotional disturbance and general symptoms in the Decreasing class than in the High (ES = -10.40, SE = 3.41, p = 0.003; ES = -22.36, SE = 10.07, p = 0.027), Increasing (ES = -11.35, SE = 4.55, p = 0.014; ES = -25.58, SE = 13.17, p = 0.050) and Low (ES = -11.38, SE = 3.29, p = 0.001; ES = -27.55, SE = 9.78, p = 0.005) classes, respectively. Conclusions: These findings suggests that in UHR subjects persistent tobacco smoking is associated with an unfavorable course of psychotic symptoms, whereas decrease in the number of cigarettes smoked is associated with improvement in affective symptoms. Future research into smoking cessation interventions in the early stages of psychoses is required to shine light on the potential of modifying smoking behavior and its relation to clinical outcomes.

The Relationship Between Grey Matter Volume and Clinical and Functional Outcomes in People at Clinical High Risk for Psychosis.

Objective: To examine the association between baseline alterations in grey matter volume (GMV) and clinical and functional outcomes in people at clinical high risk (CHR) for psychosis. Methods: 265 CHR individuals and 92 healthy controls were recruited as part of a prospective multi-center study. After a baseline assessment using magnetic resonance imaging (MRI), participants were followed for at least two years to determine clinical and functional outcomes, including transition to psychosis (according to the Comprehensive Assessment of an At Risk Mental State, CAARMS), level of functioning (according to the Global Assessment of Functioning), and symptomatic remission (according to the CAARMS). GMV was measured in selected cortical and subcortical regions of interest (ROI) based on previous studies (ie orbitofrontal gyrus, cingulate gyrus, gyrus rectus, inferior temporal gyrus, parahippocampal gyrus, striatum, and hippocampus). Using voxel-based morphometry, we analysed the relationship between GMV and clinical and functional outcomes. Results: Within the CHR sample, a poor functional outcome (GAF < 65) was associated with relatively lower GMV in the right striatum at baseline (P < .047 after Family Wise Error correction). There were no significant associations between baseline GMV and either subsequent remission or transition to psychosis. Conclusions: In CHR individuals, lower striatal GMV was associated with a poor level of overall functioning at follow-up. This finding was not related to effects of antipsychotic or antidepressant medication. The failure to replicate previous associations between GMV and later psychosis onset, despite studying a relatively large sample, is consistent with the findings of recent large-scale multi-center studies.